Originally published as JCO Early Release 10.1200/JCO.2008.21.4791 on August 17 2009

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Role of Anthracyclines in the Treatment of Early Breast Cancer

From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori; Fondazione Michelangelo, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; Swiss Cardiovascular Center, Bern, Switzerland; and the Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.

Corresponding author: Gabriel Hortobagyi, MD, Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1354, Houston, TX 77030-4009; e-mail: ghortoba{at}mdanderson.org.

Purpose To review data relating to anthracyclines in the adjuvant treatment of early breast cancer.

Design This is a report from a seminar in which the future of anthracyclines in the adjuvant treatment of breast cancer was considered. In particular, the question of whether anthracyclines should now be discarded and replaced by taxanes was addressed.

Results Accumulating data from large randomized trials indicate that genetic markers may have a role in predicting sensitivity to cytotoxic drugs. However, no reliable, validated test is available for predicting sensitivity to anthracyclines in particular. Topoisomerase II amplification and/or deletion, especially in conjunction with human epidermal growth factor receptor-2 amplification, has been proposed to fulfill this role but more data are needed. Currently, only one published trial has shown that a taxane-based regimen may be superior to an anthracycline-based regimen, but several trials indicate that combinations including both anthracyclines and taxanes may be better still. Further studies aimed at optimizing anthracyclines and taxanes in combination, and integrating biologic agents, seem to be the way forward. There is no validated test that can determine whether anthracyclines can be of greater benefit than other agents for individual patients.

Conclusion Anthracyclines have been extensively tested in clinical trials spanning several decades; currently, there are insufficient data to recommend replacing them in the adjuvant treatment of breast cancer.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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